The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in non-dialysis chronic kidney disease : a systematic review

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function

The association of physical function and physical activity with all-cause mortality and adverse clinical outcomes in non-dialysis chronic kidney disease : a systematic review

Objective: People with nondialysis-dependent chronic kidney disease (CKD) and renal transplant recipients (RTRs) have compromised physical function and reduced physical activity (PA) levels. Whilst established in healthy older adults and other chronic diseases, this association remains underexplored in CKD. We aimed to review the existing research investigating poor physical function and PA with clinical outcome in nondialysis CKD. Data sources: Electronic databases (PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials) were searched until December 2017 for cohort studies reporting objective or subjective measures of PA and physical function and the associations with adverse clinical outcomes and all-cause mortality in patients with nondialysis CKD stages 1–5 and RTRs. The protocol was registered on the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42016039060). Review methods: Study quality was assessed using the Newcastle-Ottawa Scale and the Agency for Healthcare and Research Quality (AHRQ) standards. Results: A total of 29 studies were included; 12 reporting on physical function and 17 on PA. Only eight studies were conducted with RTRs. The majority were classified as ‘good’ according to the AHRQ standards. Although not appropriate for meta-analysis due to variance in the outcome measures reported, a coherent pattern was seen with higher mortality rates or prevalence of adverse clinical events associated with lower PA and physical function levels, irrespective of the measurement tool used. Sources of bias included incomplete description of participant flow through the study and over reliance on self-report measures. Conclusions: In nondialysis CKD, survival rates correlate with greater PA and physical function levels. Further trials are required to investigate causality and the effectiveness of physical function and PA interventions in improving outcomes. Future work should identify standard assessment protocols for PA and physical function

Changes in Physical Function, Mental Status, and Independence in Daily Activities of Older People in Wirobrajan, Yogyakarta

BACKGROUND: The increasing population of older people in Indonesia induces research to understand their characteristics and changes over time. These data are needed to develop appropriate health programs for older people. This study aimed to assess changes in the physical function, mental status, and independence in daily activities of older people within six months. SUBJECTS AND METHODS: This was a cohort study conducted in Yogyakarta, Indonesia, from August 2015 to February 2016. Study subjects were 30 older people aged 60-81 years in Wirobrajan, Yogyakarta. This study used Get Up and Go Test (GUG), Borg Scale and Berg Balance Scale to assess physical function, Mini Mental State Examination (MMSE) and Hopkins Verbal Learning Test (HVLT) to assess mental status, and Activities of Daily Living (ADL) as well as Instrumental Activities of Daily Living (IADL) to assess independence in daily activities. The data were measured twice with six month interval. The data were analyzed using paired t-test, Wilcoxon test and cluster analysis. RESULTS: Statistical analysis showed: 1) A statistically significant decline in physical function as assessed in the GUG (p = 0.001) and BERG Balance Scale (p <0.001); 2) No statistically significant changes in MMSE and HVLT; 3) A significant decline in IADL (p = 0.002) compared to the data of the previous six months. Cluster analysis did not show a clear pattern of individual changes. The changes on individual level were more varied, with most subjects showed decline, but some demonstrated improvement in physical function, mental status or independence in daily activities. CONCLUSION: There was a significant decline in physical function and independence in daily activities in older people compared to the previous six months. Varied individual changes showed that older people did not change in a uniform way and similar rate. Further study to assess changes over longer time is needed for development of appropriate health programs for older people in Indonesia. Keywords: older people, physical function, mental status, activities of daily living, Indonesi

The Green function variational approximation: Significance of physical constraints

We present a calculation of the spectral properties of a single charge doped at a Cu($3d$) site of the Cu-F plane in KCuF$_{3}$. The problem is treated by generating the equations of motion for the Green's function by means of subsequent Dyson expansions and solving the resulting set of equations. This method, dubbed the variational approximation, is both very dependable and flexible, since it is a systematic expansion with precise control over elementary physical processes. It allows for deep insight into the underlying physics of polaron formation as well as for inclusion of many physical constraints, such as excluding crossing diagrams and double occupation constraint, which are not included in the Self-Consistent Born Approximation. Here we examine the role and importance of such constraints by analyzing various spectral functions obtained in second order VA.Comment: 5 pages, 1 figur